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Optical Coherence Tomography as an Adjunct During Carotid Artery Stenting for Carotid Atherosclerotic Disease

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Abstract

Purpose

Carotid artery stenting (CAS) has been proven to decrease the risk of stroke in symptomatic patients with moderate/high-grade carotid stenosis; however, there is an increased periprocedural risk of stroke with CAS compared to carotid endarterectomy. The goal of this article is to report the utilization of endovascular optical coherence tomography (OCT) during CAS to aid in the identification of stent malapposition, plaque prolapse, and adjacent residual thrombus that could cause periprocedural stroke.

Methods

Approval was obtained for endovascular OCT imaging in patients undergoing CAS. Images were obtained before and after stenting. Images were acquired with proximal balloon occlusion and saline to clear luminal blood during acquisition.

Results

A total of seven patients provided informed consent for imaging. There were no complications during image acquisition or the stenting procedure. Optical coherence tomography imaging revealed free intraluminal red thrombi, fibrous cap dissections, and thin cap fibroatheromas with underlying ulcerative plaques. Plaque herniation through stents was also demonstrated along with thrombus. Poor stent apposition was clearly visible.

Conclusion

Optical coherence tomography image acquisition was found to be safe, effective, and to provide valuable information about plaque morphology and stent-vessel interactions. The role of perioperative anticoagulation after stenting should be re-evaluated given the new findings. A study comparing CAS with and without OCT with a clinical primary outcome such as ipsilateral stroke could help determine if OCT is an innovative tool to guide stenting and antithrombotic management.

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Abbreviations

AHA:

American Heart Association

CAS:

Carotid artery stenting

CEA:

Carotid endarterectomy

OCT:

Optical coherence tomography

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Funding

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Surgery, University of Toronto, 399 Bathurst St., WW 4‑427, M5T 2S8, Toronto, ON, Canada

    Christopher R. Pasarikovski & Victor XD. Yang

  2. Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

    Joel Ramjist, Jillian Cardinell & Victor XD. Yang

  3. Division of Neurosurgery, Sunnybrook Hospital, University of Toronto, Toronto, Ontario, Canada

    Leodante da Costa & Victor XD. Yang

  4. Hurvitz Brain Sciences Research Program, Sunnybrook Research Institute, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

    Sandra E. Black

  5. Department of Medicine, Division of Neurology, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada

    Sandra E. Black

  6. University, Bioengineering and Biophotonics Laboratory, Toronto, Ontario, Canada

    Jillian Cardinell & Victor XD. Yang

Authors
  1. Christopher R. Pasarikovski
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  2. Joel Ramjist
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  3. Leodante da Costa
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  4. Sandra E. Black
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  5. Jillian Cardinell
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  6. Victor XD. Yang
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Contributions

Study concept and design: Pasarikovski, da Costa, Black, Yang. Acquisition, analysis, or interpretation of data: Pasarikovski, Ramjist, da Costa, Black, Cardinell, Yang. Drafting the article: Pasarikovski, da Costa, Black, Yang. Administrative, technical, or material support: Pasarikovski, Ramjist, da Costa, Black, Cardinell, Yang. Study supervision: Yang.

Corresponding author

Correspondence to Christopher R. Pasarikovski.

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Conflict of interest

C.R. Pasarikovski, J. Ramjist, L. da Costa, S.E. Black, J. Cardinell and V.X. Yang declare that they have no competing interests.

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Pasarikovski, C.R., Ramjist, J., da Costa, L. et al. Optical Coherence Tomography as an Adjunct During Carotid Artery Stenting for Carotid Atherosclerotic Disease. Clin Neuroradiol 30, 503–509 (2020). https://doi.org/10.1007/s00062-019-00799-9

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  • DOI: https://doi.org/10.1007/s00062-019-00799-9

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